Brief report on the development of hemorrhagic pericardial effusion after thoracic surgery for traumatic injuries

Grace Martin Niziolek*, Philip Dowzicky, Sarah Joergensen, Alea Zone, Martha M. Brinson, Niels D. Martin, Mark J. Seamon, Shariq Raza, Jay Yelon, Jeremy Cannon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction Hemorrhagic pericardial effusion (HPE) is a rare but life-threatening diagnosis that may occur after thoracic trauma. Previous reports have concentrated on delayed HPE in those who did not require initial surgical intervention for their traumatic injuries. In this report, we identify and characterize the phenomenon of HPE after emergent thoracic surgery for trauma. Methods This is a retrospective review of patients who required emergent thoracic surgery for trauma at a level 1 trauma center from 2017 to 2021. Using the institutional trauma database, demographics, injury characteristics, and outcomes were compared between patients with HPE and those without HPE after thoracic surgery for trauma. Results Ninety-one patients were identified who underwent emergent thoracic surgery for trauma. Most were young men who sustained a penetrating thoracic injury. Seven patients (7.7%) went on to develop HPE. Patients who developed HPE were younger (18 vs. 32 years, p=0.034), required bilateral anterolateral thoracotomy (85% vs. 7%, p<0.001), and were more likely to have pulmonary injuries (100% vs. 52.4%, p<0.001). Five patients with HPE survived to hospital discharge. The two patients with HPE who died were both coagulopathic and had HPE diagnosed within 4 days of injury. The median time to HPE diagnosis in survivors was 24 days with four of five HPE survivors on therapeutic anticoagulation at the time of diagnosis. Conclusions HPE may occur after emergent thoracic surgery for trauma. Those at highest risk of HPE include younger patients with bilateral thoracotomy incisions and pulmonary injuries. Early HPE, clinical signs of tamponade, and/or coagulopathy in patients with HPE portend a worse prognosis. Surgeons and trauma team members caring for patients after emergent thoracic exploration for trauma should be aware of this potentially devastating complication and should consider postoperative echocardiography in high-risk patients.

Original languageEnglish
Article numbere001090
JournalTrauma Surgery and Acute Care Open
Issue number1
StatePublished - 9 Jul 2023
Externally publishedYes


  • Cardiac Tamponade
  • Thoracic Injuries
  • Thoracic Surgical Procedures
  • postoperative complications


Dive into the research topics of 'Brief report on the development of hemorrhagic pericardial effusion after thoracic surgery for traumatic injuries'. Together they form a unique fingerprint.

Cite this